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OBJECTIVE To compare the angle of progression (AoP) measured by transperineal ultrasonography before indicating an instrumental delivery or cesarean delivery. METHODS A prospective observational study was conducted among women with singleton term pregnancies with prolonged second stage of labor at Kwong Wah Hospital, Hong Kong, China, between May 16, 2011, and May 25, 2016. Transabdominal and transperineal ultrasonography were performed to determine fetal head position and AoP, respectively, both at rest and during uterine contraction with pushing. Mode of delivery was decided after vaginal examination without relying on ultrasonography. RESULTS Of 143 women, 116 underwent successful instrumental delivery and 27 underwent cesarean delivery. Median AoP was 153.0° in the instrumental group versus 139.0° in the cesarean group at rest (P

Objectives: To study the relationship between domestic violence and postnatal blues/depression in a Chinese community. Methods: This was a prospective cohort study on 838 women after delivery in a local university teaching hospital. Between October, 2000 and February, 2001, all Chinese speaking women after delivery were invited to be interviewed by a designated research nurse using the Abuse Assessment Screen (AAS) to detect the incidence of domestic violence, the nature of violence and the perpetrator of abuse. Demographic data, pregnancy outcome, Stein's Daily Scoring System (SDSS) scores on day 2 or 3 postdelivery, Edinburgh Postnatal Depression Scale (EPDS) scores on day 2 or 3 postdelivery, 1–2 days after discharge from hospital and at 6 weeks postdelivery were compared between the abused and non-abused groups using Student's t-test, χ2-test and Fisher's exact test as appropriate. Results: A total of 139 women (16.6%) had been abused in the last year (the abused group). Of these, 87 (10.4%) had been abused during the current pregnancy. The nature of abuse was mainly verbal. Fourteen women (1.7%) had been sexually abused in the last year. The husband/boyfriend, mother-in-law and employer/colleague were the most common perpetrators of abuse. Socio-demographic factors did not differ between the two groups except that pregnancy was more likely to be unplanned in the abused group (P=0.002). The pregnancy outcome did not differ. However, the abused group had significantly higher SDSS and EPDS scores at all stages of screening (P=0.003, P=0.000, P=0.010 and P=0.001, respectively). Conclusion: The findings supported our hypothesis that the effect of domestic violence on Chinese pregnant women is mainly on their psychological well-being.

Objective: To study the incidence of domestic violence in pregnant women attending the antenatal clinic of a local teaching hospital. Study design: All pregnant women attending their first antenatal clinic in Tsan Yuk Hospital between 11th August and 3rd November, 1998 were interviewed by a designated research nurse (Y.Y.J.L.) using a standard questionnaire (Abuse Assessment Screen) to detect the incidence of domestic violence, the nature of violence, the frequency of violence and the perpetrator of abuse. Demographic factors of the abused group were compared with those of the non-abused group using student's t -test and chi-square test. Results: Pregnant women (631) were interviewed; 113 of them (17.9%) had a history of abuse; 99 women (15.7%) had been abused in the last year; 27 of them (4.3%) had been abused during their current pregnancy; 59 women (9.4%) had been sexually abused in the last year. The husband was the perpetrator in the majority of cases. The nature of violence during pregnancy was mainly psychological in the form of threats of abuse without any physical injury. Risk factors included unplanned pregnancy ( P =0.002) and women with husbands/partners who were unemployed or manual workers ( P P Conclusion: This is probably the first study on the incidence of domestic violence in pregnant women in a Chinese community. The incidence is comparable to that from American studies. Routine screening with structured questions during the antenatal visits is necessary in order to identify the abused women so as to prevent potential trauma and to interrupt existing abuse.

A 25-year-old woman (gravida 6, para 0) was admitted at 41 weeks and 3 days of pregnancy. The patient had a history of 5 previous surgical terminations. The fetus was in cephalic presentation, three-fifths above the pelvic brim, with an estimated fetal weight of 3200 g. At 2 cm cervical dilatation, artificial rupture of the membranes was performed and oxytocin augmentation commenced. Epidural analgesia was given for pain relief. There was good progress of labor and the cervix became fully dilated after 4 hours. Vaginal examination revealed a left occipitoposterior position at the S+1 level with mild caput and molding. The fetal head was deflexed and the anterior fontanelle could be felt at the right upper quadrant. Vacuum extraction was initially planned 75 minutes after full cervical dilatation. However, orbito-right anterior brow presentation was noted on repeat vaginal examination. The brow presentation was further demonstrated by intrapartum translabial ultrasound (MyLab25; Biosound Esaote, Indianapolis, IN, USA) (Fig.1). The orbitwas just below the pubic symphysis, which differs from a typical occipito-posterior presentation. No descent occurredwithmaternal pushing. Low segment cesarean delivery of a healthy female neonate weighing 3330 g was performed without complication. Brow presentation can be missed on vaginal examination [1]. Most fetuses in brow presentation will be delivered by cesarean because in this position the largemento-vertical diameter of the fetal head,which can be larger than the pelvic brim, approaches the pelvic cavity. Although in the present case themodeof deliverywas based on clinical assessment of the patient, intrapartum translabial ultrasound may help demonstrate this uncommon malpresentation and assist with subsequent management. Recent literature has suggested that intrapartum translabial ultrasound can play an important role in the objective documentation of landmarks and parameters valuable for management of the second stage of labor [2–4]. In addition, intrapartum translabial ultrasound may be useful for patient counseling and education of trainees.